THE UNIVERSITY OF SHEFFIELD STUDENT SERVICES DEPARTMENT The Chancellor’s Medal 2015 Nomination for the Chancellor’s Medal 2015 Please fill in this form in as much detail as possible, preferably typed or in dark ink (this form will be photocopied). You may attach additional sheets / supporting documentation if necessary. Nominee Details: Name _____________________________________ Registration No. ____________________ Programme Studied ___________________________________ Level of Study* ___________ *Open to all final year undergraduate students, postgraduate students completing their programme of study or research, or recent graduates of the University. Supporting Statement (demonstrating outstanding attainment in academic, sporting or other personal achievements): Continue on next page... Supporting statement continued... Nominator Details: Name(s): _____________________________________________________________ _____________________________________________________________ Address: _____________________________________________________________ Contact Email: _____________________________ Signature: _______________________________ Telephone: ______________ Date: _______________________ Please send the completed form to: Jackie Parkin, Taught Programmes Office, Level 6, Students’ Union, Western Bank, Sheffield, S10 2TG. The closing date for nominations is 30 April 2015 and you should expect to hear whether or not your nomination has been successful by the end of June 2015. Continue on next page...
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